ASDIN2014 Scientific Meeting

In Vitro Performance of Does tip design affect
the performance of 
Long‐Term Hemodialysis Catheters
a hemodialysis catheter ?
Adrian Ravenscroft Thomas M. Vesely, MD • Recirculation
Phase One Medical Saint Louis, Missouri
Hingham, Massachusetts • Tip stability
• Blood flow turbulence

Separation of Inflow from 
Catheter Tip Design Outflow
Step‐tip
Inflow into arterial lumen

Split‐tip
Outflow jet from venous lumen
Direction of
blood flow in
superior vena cava

Tip Design to Decrease Recirculation
Tip Design to Decrease Recirculation

A/V Offset Recirculation

2.0cm          8.4%
2.5cm          4.4%
3.0cm          2.4%

Separation of 
arterial and venous
end holes
ASDIN2014 Scientific Meeting

Symmetric tip design
Specific Features of
Decreases recirculation
if blood lines 
Hemodialysis Catheter Tip Design
are connected in 
reverse configuration

Description of Hemodialysis Catheters

Name Size Length Tip Design A/V Offset Sideholes Split Length

ProGlide 14.5 19cm step 30mm yes

Titan 15.5 24cm step 25mm   yes
Ultrastream 15.5 28cm step 20mm yes 25mm
30mm
Ash Split 14 28cm split 30mm yes 20mm

80mm
Centros 15 24cm split 25mm no
25mm
Hemosplit XK 16 23cm split 30mm yes 45mm ProGlide                 Titan                 Ultrastream
Equistream 16 27cm  split   12mm yes
43mm
A/V offset of step tip catheters
Palindrome         14.5 19cm symmetrical      11.5mm yes
Reversus 15.5 33cm      symmetrical       8.5mm no

45mm 80mm

25mm

11.5mm
30mm 25mm
30mm 8.5mm

Hemosplit XK           Ash Split               Centros Palindrome                 Reversus

Split length and A/V offset of split tip catheters A/V offset of symmetrical catheters
ASDIN2014 Scientific Meeting

Flow Barriers

thick
horizontal
flow barrier thin
vertical barrier
separates midline
of arterial end hole

• Location Beveled tip
Side holes : • Size & Shape
ProGlide Ultrastream
• Number

In Vitro Test System

3 independent circuits

Vertical 
glass column Viscosity of Test Fluid
simulated SVC Hematocrit (%) Viscosity (cp)

24mm x 350mm 0             1.4 (plasma)
30 1.8
Rate of blood flow
through SVC = 40 2.3
2400ml/min 50 2.9 The ICU Book
3rd Edition 2007
Catheter tip 1.0 centipoise = water
positioned in
observation zone 2.3 centipoise = blood with hematocrit = 40%
3 ‐ circuits ‐ no cellular components of blood
SVC = 2400ml/min
3 ‐ peristaltic pumps Venous lumen = 425ml/min
6 ‐ air actuated valves Arterial lumen = 425ml/min
ASDIN2014 Scientific Meeting

Measurement of Recirculation
Catheter Testing Protocol

The 9 hemodialysis catheters 
Serial dilution of blue dye 
underwent 72 testing procedures
used for colorimetric calibration

dual channel optical sensor Each catheter was tested four times at each viscosity: 
calibrated for 620nm and 800nm
‐twice with blood lines in standard configuration 
‐twice with blood lines in reverse configuration
Measurement of recirculation using indicator dye method
% recirculation correlated to absorption of blue dye
aspirated into inflow (arterial) lumen

Equistream
Standard configuration

Results • Inflow     = left limb
• Outflow  = right limb

Hemodialysis Hemodialysis
machine off machine on

Equistream
Recirculation
Reverse configuration None of the 9 catheters had recirculation 
with blood lines connected in standard configuration
• Outflow  = left limb
at both 1.0cP and 2.3cP fluid viscosity
• Inflow     = right limb (water)               (40% Hct)

With blood lines in reversed configuration
catheter tip design affected the rate of recirculation
Hemodialysis Hemodialysis
machine off machine on
ASDIN2014 Scientific Meeting

Ash Split Hemosplit
Reversed configuration
Reversed configuration

jet of blood flow jet of blood flow
directed into inflow lumen directed into inflow lumen

inflow lumen
venous end hole
is inflow lumen
Hemodialysis Hemodialysis
Hemodialysis Hemodialysis
machine off machine on
machine off machine on

ProGlide
Centros Reversed configuration
Reversed configuration

Turbulence flow 
jet of blood flow exiting catheter caused
directed into inflow lumen
tip movement
inflow lumen

rate of blood flow in SVC
= 2400ml/min

Recirculation Rate
Symmetric     Palindrome 0%
Palindrome Symmetric     Reversus 0% Recirculation rates
Split tip          Equistream 0%
when catheter connected
0% recirculation in reversed configuration
with standard and Step tip         Ultrastream 8.7%
reverse blood lines Step tip         Titan 9.4%
Step tip         ProGlide 16.3%

Split tip        Centros 22.3%
Split tip        Hemosplit XK 33.5%
Split tip        Ash Split 39.2%
Standard configuration Reversed configuration
ASDIN2014 Scientific Meeting

SVC
Catheter

Observations

Ash Split Ash Split
Standard configuration Standard configuration

jet of fluid pushes catheter

catheter tip moves 
against wall of SVC

Hemodialysis Hemodialysis
Hemodialysis Hemodialysis
machine off machine on
machine off machine on

Hemosplit XK
Hemosplit XK
With reversed blood lines
No movement of there is significant (3+)
catheter tip movement of catheter tip
with standard blood lines
at flow rate = 425ml/min
Aspiration caused
venous end hole
to adhere to SVC wall

Hemodialysis Hemodialysis Hemodialysis Hemodialysis

machine off machine on machine off machine on
ASDIN2014 Scientific Meeting

stagnant blood  stagnant blood 
between lumens between lumens

Hemosplit XK Hemosplit XK
Reverse configuration Reverse configuration

Hemodialysis Hemodialysis Hemodialysis

machine off machine on machine on

Split tip

stagnant blood 
between lumens
Step tip

Ash Split
Reversed configuration
Symmetric tip

Thrombus can develop on any catheter tip

Summary
Currently available hemodialysis catheters 
have no significant recirculation 
when connected in the standard configuration

Split tip‐type catheters have >20% recirculation
when connected in reversed configuration

Catheter tip design influences catheter stability
and the development of catheter tip thrombus
Pattern of blood flow Catheter flow
in right atrium in right atrium
ASDIN2014 Scientific Meeting